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131I治疗分化型甲状腺癌患者体内残留辐射剂量及病房辐射剂量的监测分析

Radiation monitoring in patients with differentiated thyroid carcinoma treated with iodine-131 and their wards

摘要:

目的 评估住院131I治疗分化型甲状腺癌(DTC)患者体内残留辐射剂量达到出院要求的时间,以及患者所住病房和用具的辐射情况.方法 选取2015年1月至2017年3月在中山大学附属第三医院核医学科接受术后131I住院治疗的DTC患者143例,其中男性46例、女性97例,年龄(37.6±12.4)岁.按给药剂量分为3.70、5.55和7.40 GBq 3组,每组患者分别为51、51、41例.患者在服用131I后0.5、2、4、8、12、24、36、48、72、80 h,在距离患者1m外使用实时辐射监测仪测定辐射剂量率,估算患者体内放射性活度的变化情况.在患者出院后当天应用表面辐射污染监测仪对病房环境及患者使用过的床被进行表面污染辐射剂量的监测.对3组辐射剂量率数据进行单因素方差分析.结果 服131I治疗0.5 h后3组DTC患者1m外的辐射剂量率[(597.5±196.3)、(794.5±254.2)、(1114.1±258.5)μSv/h]的差异有统计学意义(F =62.757,P<0.01),但随着时间的延长,辐射剂量水平按类似指数曲线的变化规律迅速下降,且3组间差距逐渐缩小,在服131I治疗72 h后3组患者1m外的辐射剂量率[(13.3±10.7)、(16.1±9.7)、(21.9 ± 14.5) μSv/h]的差异无统计学意义(F=2.313,P>0.05).服131I治疗后80 h 95.8%(137/143) DTC患者1m外辐射剂量率低于23.3 μSv/h.出院后患者使用过的床单、病服、病房地面及洗手间门口地面的表面剂量率分别为(3.9±1.2)、(4.1±1.9)、(3.8±1.6)、(6.2±2.6) μSv/h,均低于相应规定的辐射剂量限制水平.结论 使用不超过7.40GBq 131I治疗的DTC患者在服用131I治疗80 h后,绝大多数患者体内残留131I剂量低于国家规定的辐射限制水平.出院后患者所处病房环境及使用过的床单、病服的辐射污染均低于限制水平,无需特殊处理.

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abstracts:

Objective To evaluate how long after iodine-131 treatment of hospitalized patients with differentiated thyroid cancer (DTC),the radiation dose in patients fit the discharged requirements,as well as the radiation levels in wards and facilities in which the patients lived.Methods A total of 143 patients with DTC were hospitalized and treated with iodine-131 from January 2015 to March 2017 in the department of nuclear medicine,third affiliated hospital of Sun Yat-sen university.The participants consisted of 46 males and 97 females aged 37.6±12.4 years.The patients were divided into three groups according to the radiation dose of iodine-131.Groups 1,2,and 3 were administered with 3.70,5.55,and 7.40 GBq,respectively.After the administration of iodine-131 for 0.5,2,4,8,12,24,36,48,72,and 80 h,the radiation dose rate was measured at 1 m in front of the patients by using a realtime radiation monitor,and the changes in radioactivity in the patients were estimated.On the day after the patients were discharged,the radiation doses on the patients' clothes,bed sheets,ward floor,and ground at the bathroom door were monitored using a surface radiation monitor.Data were subjected to variance analysis,and a P<0.05 was considered statistically significant.Results Groups 1 [(597.5±196.3) μsv/h],2 [(794.5±254.2) μsv/h],and 3 [(1114.1±258.5) μsv/h] had significantly different radiation dose rates (F=62.757,P<0.01) after 0.5 h of iodine-131 administration.Prolonged radiation exposure resulted in rapid exponential decrease in the radiation dose rate and gradual reduction in the differences among the data.The radiation dose rates of groups 1,2,and 3 [(13.3±10.7),(16.1±9.7),and (21.9±14.5) μ sv/h,respectively] after 72 h of iodine-131 administration were not significantly different (F=2.313,P>0.05).The dose rate in 95.8% of the patients (137 out of 143 patients) was less than 23.3 μSv/h after approximately 80 h of iodine-131 administration.After the patients were discharged from the hospital,the surface dose rates on the bed sheets,patients' clothes,ward floor,and ground at the bathroom door were (3.9±1.2),(4.1±1.9),(3.8±1.6),and (6.2± 2.6) μsv/h,respectively.These values were lower than the corresponding radiation limit levels.Conclusions After 80 h of treatment with no more than 7.40 GBq iodine-131,the residual dose of iodine-131 in most patients was lower than its restricted value in China.The radiation pollution level of the patients' ward grounds,bed sheets,and clothes were also lower than the radiation limit.Thus,these materials and facilities require no special treatment.

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作者: 袁海娟 [1] 林主戈 [1] 吴春兴 [1] 陈宇导 [1] 周英伟 [1] 张峰 [1] 程木华 [1]
栏目名称: 放射性治疗病房的管理与防护
DOI: 10.3760/cma.j.issn.1673-4114.2019.05.003
发布时间: 2019-12-31
基金项目:
广东省自然科学基金(S2017010009273)Guangdong Natural Science Foundation
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